Folate and vitamin B12 status: temporal evaluation after mandatory fortification in Brazil.

OBJECTIVES: To perform temporal evaluation of folate and vitamin B12 status and their associated factors in a Brazilian population exposed to mandatory fortification. METHODS: Data from the cross-sectional population-based studies 2008 and 2015 Health Surveys of São Paulo, including individuals ≥ 20 years, both sexes, N = 549 in 2008 and N = 610 in 2015. Folate and vitamin B12 biomarkers status, B-complex supplements and medications use, and dietary intake were assessed. RESULTS: Serum folate concentrations increased in the entire population, adults and older adults in 2015 compared to 2008, while serum vitamin B12 concentration increased only in older adults. B-complex supplement use raised in 2015, reflecting in serum vitamins status. Overall serum vitamin B12 deficiencies (<200 pg/mL) were 23.2% and 21.2%, while serum folate deficiencies (<4 ng/mL) were 4.1% and 1.5% in 2008 and 2015, respectively. The lowest quintile of serum folate (≤8.7 ng/mL) was positively associated with smoking and oral contraceptive use, while the highest quintile (≥17.8 ng/mL) was inversely associated with smoking and positively with B-complex supplement use. The odds of having vitamin B12 deficiency was inversely associated with B-complex supplement use, higher serum folate median, higher dietary vitamin B12 intake and positively associated with using oral contraceptive. CONCLUSION: Overall deficiency of folate has decreased in 2015, being almost non-existent. Low vitamin B12 status presented similar proportions in the overall population comparing both periods, except for older adults. Different predictive variables were identified to better understand vitamins status outcomes in the most recent period of the study.

Prevalence of inadequate intake of folate in the post-fortification era: data from the Brazilian National Dietary Surveys 2008-2009 and 2017-2018.

The objectives were to compare the evolution of dietary folate intake, to estimate the prevalence of folate inadequacy (POFI) and the contribution of food groups to folate intake (dietary folate plus folic acid from fortified foods) in two post-fortification periods in the Brazilian population, according to life stages, geographic regions and per capita income. Population-based study including representative data from the National Dietary Survey - Brazilian Household Budget Surveys (NDS-HBS) 2008-2009 and 2017-2018, with a total of 32 749 (2008-2009) and 44 744 (2017-2018) individuals aged ≥ 10 years old, excluding pregnant and lactating women. The National Cancer Institute method was used to estimate the distributions of usual dietary folate intake. POFI was estimated according to estimated average requirement cut-off point method. After 10 years of the first NDS-HBS, POFI has increased in all sex-age groups, except for 10-13 years. POFI among women of reproductive age was around 30 and 40 % in 2008-2009 and 2017-2018. Higher POFI was observed in the North region. The top five food groups contributors to folate intake in Brazil were beans, breads, pasta and pizza, cakes and cookies and non-alcoholic beverages groups in both periods, differing in the rank order of the last two groups. Although being a country that has adopted mandatory folic acid flour fortification for almost two decades, increased POFI was observed in 2017-2018. This study brings significant scientific information, which can help understand folate dietary data in different contexts and consequently guide the approach for public health fortification strategies.

Dietary patterns among adolescents and associated factors: longitudinal study on sedentary behavior, physical activity, diet and adolescent health. / Padrões alimentares de adolescentes e fatores associados: estudo longitudinal sobre comportamento sedentário, atividade física, alimentação e saúde dos adolescentes.

The aim of the present study was to identify dietary patterns and associations with socioeconomic characteristics, lifestyle, nutritional status, lipid profile and inflammatory profile in adolescents. A cross-sectional study was conducted with a probabilistic sample using baseline data (2014) from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits and Adolescent Health. A total of 1,438 adolescents (10 to 14 years old) from public schools in the city of João Pessoa, Brazil, participated in the study. Data were collected on socioeconomic characteristics, nutritional status, lifestyle and the results of biochemical tests. Dietary data were obtained using the 24-hour recall method and dietary patterns were identified by exploratory factor analysis. Associations of interest were estimated using multiple logistic regression. Three dietary patterns were found: "Traditional", "Snacks" and "Western". These patterns were associated with age, socioeconomic status, parental education and lifestyle. The "Traditional" pattern was associated lower adiposity and a better lipid profile. However, with the increase in age, greater frequencies of the "Snacks" and "Western" patterns were found. The present findings underscore the need for strategies that encourage healthy behaviors.

Objetivou-se identificar padrões alimentares e sua associação com características socioeconômicas, de estilo de vida, estado nutricional, perfil lipídico e inflamatório em adolescentes. Estudo transversal, com amostra probabilística, utilizando dados da linha de base (2014) do Estudo Longitudinal sobre Comportamento Sedentário, Atividade Física, Hábitos Alimentares e Saúde de Adolescentes (LONCAAFS). Participaram 1.438 adolescentes (10 a 14 anos), da rede pública de João Pessoa-PB. Foram obtidos dados socioeconômicos, medidas antropométricas, estilo de vida e exames bioquímicos. Os dados dietéticos foram obtidos por recordatórios de 24h, sendo os padrões alimentares identificados por análise fatorial exploratória e as associações de interesse estimadas por regressão logística múltipla. Foram encontrados três padrões alimentares: "Tradicional", "Lanches" e "Ocidental" que se associaram com idade, nível socioeconômico, escolaridade dos pais e estilo de vida. O padrão "Tradicional" se mostrou associado a menor adiposidade e melhor perfil lipídico, porém com a maior idade, há maior adesão aos padrões "Lanches" e "Ocidental". Os resultados da análise do padrão alimentar de adolescentes apontam para necessidade de estratégias que incentivem comportamentos saudáveis.

Plasma metabolomics are associated with metabolic syndrome: A targeted approach.

OBJECTIVES: Advances in metabolomic tools have allowed us to gain a more comprehensive understanding of metabolic syndrome (MetS). The aim of this study was to evaluate the association between plasma metabolomic profiles and MetS. METHODS: For this study, adults without diabetes, chronic kidney disease, stroke, heart disease, or cancer and with full metabolomics, biochemical, and dietetic data available, representing a subsample of the Health Survey of Sao Paulo study (ISA-Capital; N = 130), were included. The joint interim statement consensus criteria were used for diagnosing MetS. Absolute quantification (µmol/L) of blood metabolites was achieved by targeted quantitative profiling of annotated metabolites by electrospray ionization tandem mass spectrometry in plasma samples. Mean differences in the compounds for MetS were evaluated by linear regression adjusted for confounding factors. RESULTS: Serine was inversely associated with MetS (ß = -15.04; P = 0.014). In glycerophospholipids with acyl-alkyl bonds, there was an inverse association with MetS, including phosphatidylcholine (PC) ae C42:5 (ß = -0.15; P = 0.040), PC ae C44:5 (ß = -0.15; P = 0.046), PC ae C40:4 (ß = -0.21; P = 0.014) and PC ae C44:4 (ß = -0.04; P = 0.032). CONCLUSION: Plasma metabolomic profiles were associated with MetS, especially the amino acid serine and some acyl-alkyl PCs.

Unmetabolized folic acid is associated with TNF-α, IL-1ß and IL-12 concentrations in a population exposed to mandatory food fortification with folic acid: a cross-sectional population-based study in Sao Paulo, Brazil.

PURPOSE: The study assessed associations between inflammatory markers, as cytokines, adhesion molecules and unmetabolized folic acid (UMFA) among a population exposed to mandatory fortification. METHODS: Data were collected from a cross-sectional population-based survey (n = 302) conducted in São Paulo City, Brazil. UMFA was assayed by a modified affinity-HPLC method with electrochemical detection to measure the different forms of the folate in plasma. We used a commercial test kit to analyze cytokines and adhesion molecules. Multiple logistic regressions were applied to investigate the association between inflammatory markers and UMFA. Multiple models were adjusted for sex, age, self-reported skin color, BMI and smoking status. RESULTS: The prevalence of detectable UMFA in this population was high (81.2%), with median concentration of 1.67 nmol/L. The odds ratios (95% CIs) for having higher immunological markers levels among individuals in the highest tertile of UMFA were 0.44 (0.24; 0.81) for TNF-α, 0.92 (0.49; 1.75) for CRP, 1.32 (0.70; 2.48) for ICAM, 0.99 (0.54; 1.81) for VCAM, 0.45 (0.25; 0.83) for IL-1ß, 0.74 (0.40; 1.38) for IL-6, 1.34 (0.73; 2.44) for IL-8, 0.65 (0.36; 1.18) for IL-10 and 0.49 (0.27; 0.89) for IL-12. CONCLUSION: UMFA concentrations were inversely associated with elevated proinflammatory markers (TNF-α, IL-1ß and IL-12). These results signalize a link between folate metabolism and the inflammatory status of adults in an apparently folate-replete population.

Dietary patterns of Brazilian adults in 2008-2009 and 2017-2018 / Padrões alimentares de adultos brasileiros em 2008-2009 e 2017-2018

ABSTRACT OBJECTIVES To identify dietary patterns among Brazilian adults based on the National Dietary Surveys (INA - Inquéritos Nacionais de Alimentação) in 2008-2009 and 2017-2018, and to verify in the second period the adherence to the patterns according to sociodemographic factors and Brazilian regions. METHODS We analyzed the first of two days of adults' food consumption (19-59 years) in INA data from 2008-2009 (n = 21,630) and 2017-2018 (n = 28,901). Dietary patterns were derived by exploratory factor analysis from 19 food groups, considering the complexity of the sample design. We evaluated the factor scores according to sex, age group, region, per capita income, and education for the INA data in 2017-2018. RESULTS We identified three patterns in the two surveys: (1) "traditional", characterized by rice, beans, and meat; (2) "breads and butter/margarine", characterized by breads, oils, and fats (including margarine/butter) and, coffee and teas in 2008-2009; and (3) "western", characterized by sodas, pizzas, snacks, flour, pasta, and sweets in 2017-2018. The "traditional" pattern had greater adherence among men, residents of the Midwest region and individuals with incomplete primary education. "Bread and butter/margarine" pattern had greater adherence among males, individuals aged between 40 and 59 years, from the Southeast region, and with income between 1 and 2 minimum wages per capita. Male individuals, aged between 19 and 39 years, from the South region, with per capita income greater than two minimum wages, and education level equal to or greater than primary education showed greater adherence to the "western" pattern. CONCLUSION The dietary patterns identified in 2008-2009 and 2017-2018 were similar, and we observed the maintenance of the "traditional" pattern, which includes rice, beans, and meat. Adherence to the dietary patterns varies according to sex, age group, region, per capita income, and education level.

RESUMO OBJETIVOS Identificar padrões alimentares entre adultos brasileiros a partir dos Inquéritos Nacionais de Alimentação (INA) 2008-2009 e 2017-2018, verificando, nesse último período, a aderência aos padrões de acordo com fatores sociodemográficos e regiões brasileiras. MÉTODOS Foram analisados dados do primeiro de dois dias de consumo alimentar de adultos (19-59 anos de idade) entrevistados nos INA 2008-2009 (n = 21.630) e 2017-2018 (n = 28.901). Os padrões alimentares foram derivados por análise fatorial exploratória a partir de 19 grupos de alimentos, considerando a complexidade do desenho amostral. Para o INA 2017-2018, os escores fatoriais foram avaliados de acordo com sexo, faixa etária, região, renda per capita e escolaridade. RESULTADOS Foram identificados três padrões nos dois inquéritos: (1) "tradicional", caracterizado por arroz, feijão e carnes; (2) "pães e manteiga/margarina", caracterizado por pães, óleos e gorduras (incluindo margarina/manteiga) e, em 2008-2009, café e chás; e (3) "ocidental", caracterizado por refrigerantes e pizzas e salgados, além de farinhas e massas e doces em 2017-2018. O padrão "tradicional" teve maior aderência entre homens, moradores da região Centro-Oeste e indivíduos com ensino fundamental incompleto. Para o padrão "pães e manteiga/margarina", observou-se maior aderência entre o sexo masculino, indivíduos com idade entre 40 e 59 anos, da região Sudeste e com renda entre 1 e 2 salários-mínimos per capita. Indivíduos do sexo masculino, com idades entre 19 e 39 anos, da região Sul, com renda per capita maior que dois salários-mínimos e escolaridade igual ou maior que o ensino fundamental foram os que apresentaram maior adesão ao padrão "ocidental". CONCLUSÃO Os padrões alimentares identificados em 2008-2009 e 2017-2018 foram similares, com manutenção do padrão "tradicional", que inclui arroz, feijão e carnes. A adesão aos padrões varia de acordo com sexo, faixa etária, região, renda per capita e escolaridade.

Technology in Health: Brazilian version of the GloboDiet program for dietary intake assessment in epidemiological studies. / Tecnologia em Saúde: versão brasileira do software GloboDiet para avaliação do consumo alimentar em estudos epidemiológicos.

The 24-hour recall (R24h) has been the method for dietary assessment in surveys. Technological advances have allowed the development of a program for the collection of R24h data. International Agency for Research on Cancer-World Health Organization (IARC-WHO) developed a standardized interview and computer-based 24-hour dietary recall program called GloboDiet, aimed at using it in research and nutrition surveillance. Brazil was included in a project for the global expansion of this methodology for developing and adapting a version for national use. The adaptation followed the procedures established by the IARC-WHO that considered the translation and adaptation of approximately 70 databases. For the development of the food list, national databases of food consumption from national surveys were consulted obtaining a final list of 2113 foods and recipes. GloboDiet program guides an interview in five steps: general information of the participant; quick list of foods and recipes; details of food / recipes and quantities consumed using mainly a picture book; control of the amount of food and nutrients; and information on dietary supplements. The Brazilian version of the GloboDiet program will provide a more accurate assessment of food intake based on a standardized method for nutrition surveillance and investigation of the relationship between diet and health outcomes, as well as comparisons of dietary intakes within and between countries.

O Recordatório Alimentar de 24 horas (R24h) tem sido o método de escolha para a avaliação da dieta em inquéritos populacionais. Os avanços tecnológicos permitiram o desenvolvimento de softwares para a coleta de dados de R24h. A International Agency for Research on Cancer-World Health Organization (IARC-WHO) desenvolveu metodologia para avaliação do consumo alimentar de forma padronizada e personalizada, o GloboDiet, com o objetivo de utilizá-la em pesquisas e em estudos de vigilância alimentar e nutricional. O Brasil, inserido em um projeto para expansão global dessa metodologia, desenvolveu e adaptou uma versão para uso nacional. A adaptação considerou a tradução e adequação de aproximadamente 70 bases de dados. Para a elaboração da lista de alimentos, foram consultados bancos de dados nacionais de estudos de consumo alimentar, obtendo-se um rol de 2.113 alimentos e receitas. O software GloboDiet orienta uma entrevista que se desenvolve em cinco etapas: informações gerais do participante; lista rápida de alimentos e receitas; detalhamento dos alimentos/das receitas e das quantidades consumidas por meio, principalmente, do manual fotográfico; controle da quantidade de alimentos e nutrientes; e informações sobre o uso de suplementos dietéticos. A versão brasileira do software proporcionará uma avaliação mais acurada do consumo alimentar com base em uma metodologia padronizada para fins de vigilância alimentar e nutricional e de investigação da relação da dieta com desfechos em saúde, além de permitir a comparabilidade dos dados de consumo alimentar em estudos no âmbito nacional e internacional.

Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil.

PURPOSE: Our aim was to estimate the prevalence of folate inadequacy (POFI) according to life stage, socio-economic status, and geographical regions after the mandatory fortification of wheat and maize flour in Brazil. METHODS: This was a population-based study. Data from two non-consecutive food records from the National Dietary Survey/Household Budget Survey 2008-2009 were used to estimate the usual dietary folate intake in µg dietary folate equivalents (DFEs). The National Cancer Institute method was used to account for within-person variance and the Estimated Average Requirement (EAR) cut-point method was used to calculate the POFI. The survey included 32,749 individuals, 15,700 males and 17,049 females, over 10 years old. Pregnant women, lactating women, and individuals with unreliable energy intake data were excluded. RESULTS: Overall POFI was 31.5% and mean dietary folate intake was 411.1 µg DFE. The lowest POFI occurred in the youngest age group of 10-13 years in both sexes, while the highest POFI was observed in the group ≥ 71 years. In women of childbearing age, POFI was around 32%. The lowest income strata had the highest POFI. The most developed regions (South and Southeast) had the lowest POFI compared to less developed regions. CONCLUSIONS: Our data show that folate inadequacy is still prevalent in Brazil mainly in low-income groups and less developed regions. Actions need to be taken to ensure that women of childbearing age, who presented a high prevalence of inadequate folate intake, achieve the recommended daily intake of 400 µg DFEs.

Tecnologia em Saúde: versão brasileira do software GloboDiet para avaliação do consumo alimentar em estudos epidemiológicos / Technology in Health: Brazilian version of the GloboDiet program for dietary intake assessment in epidemiological studies

RESUMO: O Recordatório Alimentar de 24 horas (R24h) tem sido o método de escolha para a avaliação da dieta em inquéritos populacionais. Os avanços tecnológicos permitiram o desenvolvimento de softwares para a coleta de dados de R24h. A International Agency for Research on Cancer-World Health Organization (IARC-WHO) desenvolveu metodologia para avaliação do consumo alimentar de forma padronizada e personalizada, o GloboDiet, com o objetivo de utilizá-la em pesquisas e em estudos de vigilância alimentar e nutricional. O Brasil, inserido em um projeto para expansão global dessa metodologia, desenvolveu e adaptou uma versão para uso nacional. A adaptação considerou a tradução e adequação de aproximadamente 70 bases de dados. Para a elaboração da lista de alimentos, foram consultados bancos de dados nacionais de estudos de consumo alimentar, obtendo-se um rol de 2.113 alimentos e receitas. O software GloboDiet orienta uma entrevista que se desenvolve em cinco etapas: informações gerais do participante; lista rápida de alimentos e receitas; detalhamento dos alimentos/das receitas e das quantidades consumidas por meio, principalmente, do manual fotográfico; controle da quantidade de alimentos e nutrientes; e informações sobre o uso de suplementos dietéticos. A versão brasileira do software proporcionará uma avaliação mais acurada do consumo alimentar com base em uma metodologia padronizada para fins de vigilância alimentar e nutricional e de investigação da relação da dieta com desfechos em saúde, além de permitir a comparabilidade dos dados de consumo alimentar em estudos no âmbito nacional e internacional.

ABSTRACT: The 24-hour recall (R24h) has been the method for dietary assessment in surveys. Technological advances have allowed the development of a program for the collection of R24h data. International Agency for Research on Cancer-World Health Organization (IARC-WHO) developed a standardized interview and computer-based 24-hour dietary recall program called GloboDiet, aimed at using it in research and nutrition surveillance. Brazil was included in a project for the global expansion of this methodology for developing and adapting a version for national use. The adaptation followed the procedures established by the IARC-WHO that considered the translation and adaptation of approximately 70 databases. For the development of the food list, national databases of food consumption from national surveys were consulted obtaining a final list of 2113 foods and recipes. GloboDiet program guides an interview in five steps: general information of the participant; quick list of foods and recipes; details of food / recipes and quantities consumed using mainly a picture book; control of the amount of food and nutrients; and information on dietary supplements. The Brazilian version of the GloboDiet program will provide a more accurate assessment of food intake based on a standardized method for nutrition surveillance and investigation of the relationship between diet and health outcomes, as well as comparisons of dietary intakes within and between countries.

Presence of circulating folic acid in plasma and its relation with dietary intake, vitamin B complex concentrations and genetic variants.

PURPOSE: The aim of this study was to investigate circulating folic acid (FA) and predict circulating FA concentrations in the population related to dietary intake, vitamin concentrations, and interaction with the genetic variants involved in folate metabolism. METHODS: Data were from the 'Health Survey of São Paulo' a cross-sectional population-based survey, conducted in São Paulo City, Brazil. The participants (n = 750) provided fasting blood samples and food intake data. Folate, homocysteine, and B6 and B12 vitamins were assayed. DNA was isolated, and the genotypes for polymorphisms involved in folate metabolism were determined. A generalized linear model was performed to predict circulating FA concentration. RESULTS: The circulating FA was detected in 80.0% of the population, with a median concentration of 1.6 nmol/L (IQR 0.5-2.9). The increase of circulating FA concentrations was directly associated with total folate concentration (ß coeff. 1.03; 95% CI 1.02-1.04), age (ß coeff. 1.01; 95% CI 1.01-1.02), current smoker (ß coeff. 1.51; 95% CI 1.16-1.97), self-reported skin color (ß coeff. 1.83; 95% CI 1.51-2.20), as well as interaction between folate concentration and 19-bp deletion polymorphism in DHFR (ß coeff. 1.02; 95% CI 1.01-1.03), and inversely associated with vitamin B6 (ß coeff. 0.99; 95% CI 0.98-0.99). CONCLUSIONS: In the current study, the presence of detectable circulating folic acid is high, and its concentration is elevated compared with other populations. Age, smoking, lower concentration of vitamin B6 and genetic variant are associated with increased levels of circulating FA. Further researches are needed to acknowledge and guarantee the safety of exposure to folic acid, especially in countries which have mandatory fortification.

Coffee Consumption and Coronary Artery Calcium Score: Cross-Sectional Results of ELSA-Brasil (Brazilian Longitudinal Study of Adult Health).

BACKGROUND: Available evidence for the relationship between coffee intake and subclinical atherosclerosis is limited and inconsistent. This study aimed to evaluate the association between coffee consumption and coronary artery calcium (CAC) in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). METHODS AND RESULTS: This cross-sectional study is based on baseline data from participants of the ELSA-Brasil cohort. Only participants living in São Paulo, Brazil, who underwent a CAC measurement (n=4426) were included. Coffee consumption was collected using a food frequency questionnaire. CAC was detected with computed tomography and expressed as Agatston units. CAC was further categorized as an Agatson score ≥100 (CAC ≥100). In multiple logistic regression analysis considering intake of coffee and smoking status interaction, significant inverse associations were observed between coffee consumption (>3 cups/d) and CAC≥100 (odds ratio [OR]: 0.85 [95% confidence interval, 0.58-1.24] for ≤1 cup/d; OR: 0.73 [95% confidence interval, 0.51-1.05] for 1-3 cups/d; OR: 0.33 [95% confidence interval, 0.17-0.65] for >3 cups/d). Moreover, there was a statistically significant interaction effect for coffee consumption and smoking status (P=0.028 for interaction). After stratification by smoking status, the analysis revealed a lower OR of coronary calcification in never smokers drinking >3 cups/d (OR: 0.37 [95% confidence interval, 0.15-0.91]), whereas among current and former smokers, the intake of coffee was not significantly associated with coronary calcification. CONCLUSIONS: Habitual consumption of >3 cups/d of coffee decreased odds of subclinical atherosclerosis among never smokers. The consumption of coffee could exert a potential beneficial effect against coronary calcification, particularly in nonsmokers.

Association between Coffee Consumption and Its Polyphenols with Cardiovascular Risk Factors: A Population-Based Study.

Epidemiological studies have examined the effect of coffee intake on cardiovascular disease, but the benefits and risks for the cardiovascular system remain controversial. Our objective was to evaluate the association between coffee consumption and its polyphenols on cardiovascular risk factors. Data came from the "Health Survey of São Paulo (ISA-Capital)" among 557 individuals, in São Paulo, Brazil. Diet was assessed by two 24-h dietary recalls. Coffee consumption was categorized into <1, 1-3, and ≥3 cups/day. Polyphenol intake was calculated by matching food consumption data with the Phenol-Explorer database. Multiple logistic regression models were used to assess the associations between cardiovascular risk factors (blood pressure, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, fasting glucose, and homocysteine) and usual coffee intake. The odds were lower among individuals who drank 1-3 cups of coffee/day to elevated systolic blood pressure (SBP) (Odds Ratio (OR) = 0.45; 95% Confidence Interval (95% CI): 0.26, 0.78), elevated diastolic blood pressure (DBP) (OR = 0.44; 95% CI: 0.20, 0.98), and hyperhomocysteinemia (OR = 0.32; 95% CI: 0.11, 0.93). Furthermore, significant inverse associations were also observed between moderate intake of coffee polyphenols and elevated SBP (OR = 0.46; 95% CI: 0.24, 0.87), elevated DBP (OR = 0.51; 95% CI: 0.26, 0.98), and hyperhomocysteinemia (OR = 0.29; 95% CI: 0.11, 0.78). In conclusion, coffee intake of 1-3 cups/day and its polyphenols were associated with lower odds of elevated SBP, DBP, and hyperhomocysteinemia. Thus, the moderate consumption of coffee, a polyphenol-rich beverage, could exert a protective effect against some cardiovascular risk factors.

The effect of coffee intake on lysophosphatidylcholines: A targeted metabolomic approach.

BACKGROUND & AIM: Lysophosphatidylcholines (lysoPC) are known to be a pathological component of oxidized-LDL, and several studies demonstrate its pro-inflammatory properties in vitro. Nevertheless, bioactive compounds found in coffee, such as phenolic acids might inhibit LDL oxidation. The relationship between coffee consumption and lysoPC has not been described previously in humans. The aim of the present study was to assess the association between coffee intake and plasma lysoPC levels in adults. METHODS: Data was from the "Health Survey of Sao Paulo (ISA-Capital)", a cross-sectional population-based survey in Sao Paulo, among 169 individuals aged 20 years or older. This population was categorized into three groups: non-coffee consumers (0 mL/day-G1), low coffee consumers (≤100 mL/day-G2), and high coffee consumers (>100 mL/day-G3). Usual coffee intake was estimated by two 24HR and one FFQ, using Multiple Source Method. Quantification of the metabolites was performed by mass spectrometry (FIA-MS/MS and HPLC-MS/MS) and 14 lysoPC species were identified. The association between coffee intake and lysoPC was analyzed by multiple linear regression adjusted for age, sex, household per capita income, smoking, physical activity, body mass index, total energy intake, use of drugs, vegetables and fruit consumption and caffeine intake. RESULTS: LysoPC levels were significantly lower in G3 than in G1, for the lysoPC a C16:1 (ß = -0.56; p = 0.014), lysoPC a C18:1 (ß = -2.57; p = 0.018), and lysoPC a C20:4 (ß = -1.14; p = 0.037). In opposition, the ratios of C16:0/C16:1 and C18:0/18:1 was higher in G3 (ß = 5.04; p = 0.025 and ß = 0.28; p = 0.003, respectively). CONCLUSION: LysoPC profile differed according to coffee intake, showing a possible beneficial health effect of this beverage on inflammatory and oxidative processes.

Brazilians' experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy.

OBJECTIVE: To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a population-based study, reflecting before and after the mandatory fortification of flour with Fe. DESIGN: Two cross-sectional population-based studies conducted in 2003 and 2008. Dietary intake was evaluated by 24 h recall and the Software for Intake Distribution Estimation (PC-SIDE) was used to estimate within-person variance and prevalence of inadequate Fe intake. The statistical analysis was conducted considering the complex survey design. SETTING: São Paulo, Brazil. SUBJECTS: Adolescents, adults and elderly adults of both sexes, interviewed in 2003 (n 2386) and 2008 (n 1661). RESULTS: The Fe intake mean increased in all populations in the post-fortification period. A reduction of over 90 % was observed in the prevalence of inadequate Fe intake among men for all age groups analysed. When evaluating women, despite the substantial reduction (over 63 %), prevalence of inadequate Fe intake remained high (34 %) in those aged 19-50 years. Major food contributors to Fe intake before fortification were beans, beef, vegetables and dairy. There was an alteration in the contributors in the post-fortification period, with bread, beef, beans and biscuits as main contributors. CONCLUSIONS: The mandatory fortification with Fe significantly furthered the reduction in the prevalence of inadequacy, except among women of reproductive age, and changed the main contributors to this nutrient in the studied population. Therefore, monitoring of Fe addition in flour is essential to assess compliance to the fortified flour policy and to guarantee a safe Fe intake for all the population.

Association between Polyphenol Intake and Hypertension in Adults and Older Adults: A Population-Based Study in Brazil.

BACKGROUND/OBJECTIVE: Hypertension is an important risk factor for cardiovascular disease, and diet has been identified as a modifiable factor for preventing and controlling hypertension. Besides, epidemiological studies have suggested an inverse association between polyphenol intake and cardiovascular diseases. The aim of this study was to evaluate the association between the intake of polyphenols and hypertension in a general population of Sao Paulo. METHODS: Data came from the 'Health Survey of Sao Paulo (ISA-Capital)' among 550 adults and older adults in Sao Paulo, Brazil. Diet was assessed by two 24-hour dietary recalls (24HR). Usual intakes were calculated using the Multiple Source Method. Polyphenol intake was calculated by matching food consumption data from the 24HR with the Phenol-Explorer database. The associations between the hypertension and tertiles of the total and classes of polyphenols intake were tested by multivariate logistic regression analysis. RESULTS: After multivariate adjustment for potential confounding factors the findings showed an inverse and linearly association between the hypertension and highest tertiles of tyrosols (OR = 0.33; 95%CI 0.18, 0.64), alkylphenols (OR = 0.45; 95%CI 0.23, 0.87), lignans (OR = 0.49; 95%CI 0.25, 0.98), as well as stilbenes (OR = 0.60; 95%CI 0.36, 0.98), and other polyphenols (OR = 0.33; 95%CI 0.14, 0.74). However, total polyphenol intake, and phenolic acids were significantly associated only in the middle tertile with hypertension and flavonoids were not significant associated. CONCLUSION: There is an inverse and linearly association between the highest tertile of some classes of polyphenols, such as, tyrosols, alkylphenols, lignans, stilbenes, other polyphenols and hypertension.

High folic acid intake reduces natural killer cell cytotoxicity in aged mice.

Presence of unmetabolized folic acid in plasma, which is indicative of folic acid intake beyond the metabolic capacity of the body, is associated with reduced natural killer (NK) cell cytotoxicity in postmenopausal women ≥50years. NK cells are cytotoxic lymphocytes that are part of the innate immune system critical for surveillance and defense against virus-infected and cancer cells. We determined if a high folic acid diet can result in reduced NK cell cytotoxicity in an aged mouse model. Female C57BL/6 mice (16-month-old) were fed an AIN-93M diet with the recommended daily allowance (1× RDA, control) or 20× RDA (high) folic acid for 3months. NK cytotoxicity was lower in splenocytes from mice fed a high folic acid diet when compared to mice on control diet (P<.04). The lower NK cell cytotoxicity in high folic acid fed mice could be due to their lower mature cytotoxic/naïve NK cell ratio (P=.03) when compared to the control mice. Splenocytes from mice on high folic acid diet produced less interleukin (IL)-10 when stimulated with lipopolysaccharide (P<.05). The difference in NK cell cytotoxicity between dietary groups was abolished when the splenocytes were supplemented with exogenous IL-10 prior to assessment of the NK cytotoxicity, suggesting that the reduced NK cell cytotoxicity of the high folic acid group was at least partially due to reduced IL-10 production. This study demonstrates a causal relationship between high folic acid intake and reduced NK cell cytotoxicity and provides some insights into the potential mechanisms behind this relationship.

Folate and nutrients involved in the 1-carbon cycle in the pretreatment of patients for colorectal cancer.

To assess the ingestion of folate and nutrients involved in the 1-carbon cycle in non-treated patients with colorectal adenocarcinoma in a reference center for oncology in southeastern Brazil. In total, 195 new cases with colorectal adenocarcinoma completed a clinical evaluation questionnaire and a Food Frequency Questionnaire (FFQ). Blood samples from 161 patients were drawn for the assessment of serum folate. A moderate correlation was found between serum concentrations of folate, folate intake and the dietary folate equivalent (DFE) of synthetic supplements. Mulatto or black male patients with a primary educational level had a higher intake of dietary folate. Of patients obtaining folate from the diet alone or from dietary supplements, 11.00% and 0.10%, respectively, had intake below the recommended level. Of the patients using dietary supplements, 35% to 50% showed high levels of folic acid intake. There was a prevalence of inadequacy for vitamins B2, B6 and B12, ranging from 12.10% to 20.18%, while 13.76% to 22.55% of patients were likely to have adequate choline intake. The considerable percentage of patients with folate intake above the recommended levels deserves attention because of the harmful effects that this nutrient may have in the presence of established neoplastic lesions.

Consumo dietético, variantes genéticas e relação com níveis sanguíneos de folato, ácido fólico não metabolizado e homocisteína após a fortificação mandatória de ácido fólico: estudo de base populacional - ISA - Capital / Dietary intake and genetic variants of folate and its relation to folate, unmetabolized folic acid and homocysteine blood concentrations after mandoty folic acid fortification population based study ISA-Capital

Em diversos países, inclusive no Brasil, a fortificação de alimentos com ácido fólico (AF) foi adotada como política pública de prevenção e combate à deficiência nutricional da vitamina, motivados principalmente pela redução da incidência dos defeitos do tubo neural. No período pós-fortificação observa-se tanto a evolução positiva do consumo e nível sérico da vitamina quanto a diminuição da concentração plasmática de homocisteína, e ainda, o aumento do ácido fólico não metabolizado na maioria desses países. Não se conhece ainda os efeitos biológicos do AFNM, no entanto, considera-se que o AFNM pode ser um fator relevante nas questões de segurança associadas com alto consumo de AF. Objetivo: Avaliar o consumo dietético e nível de folato, homocisteína e ácido fólico não metabolizado após a fortificação mandatória de alimentos com ácido fólico, e a interação com os polimorfismos envolvidos no metabolismo do folato e homocisteína. Metodologia: Os dados foram oriundos do estudo transversal de base populacional ISA Capital 2008 conduzido em uma amostra representativa de residentes do município de São Paulo, de ambos os sexos, e com idade acima de 14 anos. Coletou-se recordatórios alimentares de 24 horas e amostra de sangue em jejum de 12 horas para análises bioquímicas e moleculares. As análises estatísticas foram realizadas no programa STATA®, versão 13.0, com nível de significância de 5 por cento . Resultados: O estudo foi conduzido em 750 indivíduos, sendo 53,1 por cento mulheres e média de idade 40,7 (IC95 por cento 38,8-42,5) anos. A média de consumo e nível de folato foi de 375,8 (IC95 por cento 363,0-388,6) mcg/dia e 13 (IC95 por cento 12,0-13,9) ng/ml, respectivamente...

Food fortification is an important strategy in public health policy for controlling micronutrient malnutrition, and a major contributory factor in the eradication of micronutrients deficiencies. Motivated by the reduction in the occurrence of neural tube defects, countries worldwide, including Brazil, adopted food fortification with folic acid (FA). Folic acid fortification has increased dietary intakes of folic acid and folate status, but it is also associated with the presence of circulating FA. Although the metabolism and biological effects of circulating of folic acid are not well known, it may be a contributing factor in safety concerns associated with high oral doses of folic acid. Objective: To assess the folate intake and status, homocysteine and circulating FA after mandatory fortification with folic acid, and interaction with polymorphisms involved in 1-carbon metabolism. Material and Methods: Data were from 750 individuals aged > 14 years old who participated of a cross-sectional population-based survey in Sao Paulo City-Brazil. Fasting blood samples and information about food intake based on two measures of 24 hour food recall were collected. All analyses were carried out using STATA (version 13.0) and p-value <.05 was considered to be statistically significant in all tests. Results: Results were from 750 individuals...

Ingestão de folato nos períodos pré e pós-fortificação mandatória: estudo de base populacional em São Paulo, Brasil / Folic acid intake before and after mandatory fortification: a population-based study in São Paulo, Brazil / Ingesta de folatos en la prefortificación o posfortificación: estudio de base poblacional en São Paulo, Brasil

Analisou-se a ingestão de folato nos períodos pré e pós-fortificação. Os dados dietéticos foram coletados por recordatório de 24 horas (R24h) no Inquérito de Saúde de São Paulo (ISA-Capital) em 2003 e 2007/2008, estratificando-se a população segundo fase da vida e sexo. Utilizaram-se os valores de recomendação: necessidade média estimada (EAR) e nível máximo de ingestão tolerada (UL) e o método "EAR como ponto de corte" para estimar a inadequação da ingestão. Houve redução na prevalência de inadequação da ingestão de folato em todos os estratos, com destaque para os adolescentes e adultos do sexo masculino, de 72% para < 1% e de 76% para 6%, mas nas mulheres adultas a inadequação permaneceu elevada (38%). Antes da fortificação, o feijão foi o alimento que mais contribuiu para a ingestão de folato; após, o maior contribuinte passou a ser o pão, porém o feijão permaneceu importante. A fortificação foi bem-sucedida (aumentou a ingestão dentro de níveis seguros), porém, gera preocupação a elevada proporção no grupo alvo, mulheres adultas, que não atingem a recomendação para ingestão de folato.

This study analyzed folic acid intake before and since mandatory fortification. Dietary data were collected by 24-hour recall in a health survey in São Paulo (ISA-Capital) in 2003 and 2007-2008, stratifying the population according to life stage and gender. Estimated average requirement (EAR) and tolerable upper intake level (UL) were used to assess intake. Prevalence of inadequate folic acid intake decreased in all groups, especially adolescents and adult males (72% to < 1% and 76% to 6%, respectively) but remained high in adult women (38%). Beans were the main source of folic acid before fortification. With fortification, bread became the main source, but beans remained important. Fortification was successful (increased intake within safe levels), but it raised concerns about the high proportion in the target group (adult women) who still fail to meet the recommended intake.

Se analizó la ingesta de folato en los periodos de pre- y posfortificación. Los datos dietéticos se recogieron mediante un recordatorio de 24 horas en la Encuesta de Salud de São Paulo (ISA-Capital) en 2003 y 2007/2008, estratificando la población según etapa de la vida y sexo. Se utilizaron los valores de recomendación: necesidad media estimada (EAR) y la ingesta máxima tolerable (UL) y el método "EAR como punto de corte" para estimar la ingesta inadecuada. Se observó una reducción en la prevalencia de ingesta inadecuada de folato en todos los grupos, especialmente en los adolescentes y adultos varones, de un 72% a < 1% y de un 76% a un 6%, no obstante, en las mujeres adultas, la inadecuación seguía siendo alta (38%). Antes de la fortificación, los frijoles son el alimento que más contribuye a la ingesta de folato, después es el pan el que también constituye una fuente de folato, pese a que los frijoles siguen siendo los más importantes. La fortificación fue exitosa (aumento de la ingesta dentro de niveles seguros), sin embargo, se plantea una preocupación por el alto porcentaje del grupo objetivo: mujeres adultas que no cumplen con la recomendación para la ingesta de ácido fólico.

Folato, B6 e B12 na adolescência: níveis séricos, prevalência de inadequação de ingestão e alimentos contribuintes / Folate, vitamin B6 and vitamin B12 in adolescence: serum concentrations, prevalence of inadequate intakes and sources in food

OBJETIVO: Investigar os níveis séricos e a prevalência de inadequação da ingestão dietética de folato e das vitaminas B6 e B12, identificando os alimentos contribuintes para a ingestão desses nutrientes. MÉTODOS: Estudo observacional, transversal, em adolescentes de 16 a 19 anos, de ambos os sexos, conduzido em Indaiatuba (SP). Coletou-se o registro alimentar de 3 dias não consecutivos. A dieta habitual foi estimada pela remoção da variabilidade intrapessoal, e a prevalência de inadequação da ingestão, pelo método da estimated average requirement como ponto de corte. As análises bioquímicas de folato, B6 e B12 foram conduzidas de acordo com os métodos aceitos na literatura. RESULTADOS: O estudo foi conduzido com 99 adolescentes, a maioria do sexo feminino (58,6 por cento), com média de idade de 17,6 (desvio padrão, DP 0,9) anos. As médias da concentração sérica de folato, B6 e B12 foram de 9,2 (DP 3,4) ng/mL, 18,7 (DP 5,1) nmol/L e 397,5 (DP 188,4) pg/mL, respectivamente; e a prevalência de inadequação da ingestão das vitaminas foi de 15,2, 10,2 e < 1 por cento, respectivamente. Os alimentos que mais contribuíram para a ingestão dos nutrientes foram, para folato: pão francês, macarrão e feijões; para B6: arroz branco, carne de frango e carne bovina; e para B12: carne bovina magra, leite integral e carne bovina gorda. CONCLUSÕES: As prevalências de inadequação de folato, B6 e B12 mostraram-se baixas, possivelmente em decorrência da melhoria do acesso e da disponibilidade de alimentos, fontes dietéticas das vitaminas. Os feijões, presentes na dieta tradicional brasileira, ainda estão entre os principais alimentos que contribuíram para a ingestão de folato, mesmo após a fortificação mandatória com ácido fólico no Brasil.

OBJECTIVE: To investigate serum concentrations and the prevalence of inadequate folate intake and also vitamin B6 and vitamin B12 intakes and to identify those foods that make a major contribution to intake levels of these nutrients. METHODS: This was a cross-sectional, observational study of adolescents of both sexes aged 16 to 19 years from the town of Indaiatuba, SP, Brazil. Data collection was by non-consecutive 3-day dietary record. The samples’ habitual diet was estimated by removing intraindividual variability, and the prevalence rates of inadequate intakes were calculated using the estimated average requirement as cutoff points. Biochemical assays for folate, vitamin B6 and vitamin B12 were conducted in accordance with the methods accepted in the literature. RESULTS: The study sample comprised 99 adolescents, the majority of whom were female (58.6 percent), with a mean age of 17.6 [standard deviation, (SD) 0.9]. Mean serum concentrations for folate, vitamin B6 and vitamin B12 were 9.2 (SD 3.4) ng/mL, 18.7 (SD 5.1) nmol/L and 397.5 (SD 188.4) pg/mL, respectively; and the prevalence rates of inadequate intake for these vitamins were 15.2, 10.2 and < 1 percent, respectively. The foods that made a major contribution to vitamin intakes were French bread, pasta and beans for folate; white rice, chicken and beef for vitamin B6; and lean beef, whole milk and fatty beef for vitamin B12. CONCLUSIONS: The prevalence rates of inadequate folate, vitamin B6 and vitamin B12 intakes were low, which is possibly the result of improved access to and availability of foods that are dietary sources of these vitamins. Beans, which are a part of the traditional Brazilian diet, remain one of the primary food items that contribute to folate intake, even after mandatory fortification with folic acid in Brazil.